Matthew Michela, president and CEO of Life Image.
Healthcare's stubborn reliance on faxes, paper, and CDs has demonstrated that its aging infrastructure is not an adequate match in medical warfare against a novel virus that moves at internet speed.
The federal rules to advance interoperability and data sharing, which were finalized in March 2020 by the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT (ONC), brought an unprecedented opportunity to contemporize digital health in order to match the needs of a modern healthcare system. Unfortunately, shortly after the rules were finalized, COVID-19 began spreading across the country and healthcare stakeholders were presented with a balancing act: Prepare for a stressed health system or implement a sweeping federal rule.
As resources were maxed out, many hospital staff were furloughed or repositioned to address COVID-19 and, understandably, the ONC rules were pushed aside by more pressing concerns. The virus quickly became the only priority the industry could focus on. As a result, in mid-April, the ONC announced enforcement discretion that will delay compliance for some standards for up to three months to allow for the industry to properly manage the impact of both substantial events.
The irony is that COVID-19 has demonstrated that healthcare has already taken too long to advance, digitize, and virtualize care, which was precisely what was needed to combat the pandemic. Fast-tracking interoperability is exactly what the ONC rules had hoped to accomplish on a more controlled level.
Clinical relevance of imaging
COVID-19 is a significant respiratory illness primarily affecting the lungs but also impacting other major organs, including the heart, kidneys, liver, and brain. Diagnostic imaging plays a significant role in diagnosis, treatment, recovery monitoring, and post-acute care.
Considering that half of all U.S. counties lack access to intensive care units (ICU), the healthcare industry's response to the pandemic will rely on virtual care through telehealth and teleradiology outside of traditional healthcare settings. The coordination of virtual care requires the ability to access and share medical information digitally between patients and care teams in geographically dispersed areas.
Medical information such as imaging, which has historically been siloed, must now be more readily available. The ONC understood the importance of imaging and formally identified it as a clinically relevant data element in the patient health record within its U.S. Core Data for Interoperability (USCDI). Imaging must therefore be shared without special effort.
Many of the larger, more urban health systems have digital connections in place with their main referral sites. However, no site is fully digital. Many smaller institutions, and especially those in more rural communities, are not yet connected for digital transfer. It is imperative to establish these digital connections, which can be done quickly and cost-effectively without a lot of demand on hospital IT staff. Mature technology currently exists, so there's no need to create or implement new or untested technologies.
Although health systems have made some gains in interoperability, sharing images and data with patients happens at such a small scale that some consider it to be practically nonexistent.
Creating digital connections
Life Image recently conducted a patient survey with 1,300 respondents, finding that nearly 40% of patients are still required to physically travel to pick up CDs if they want access to their medical records and related imaging. What's more, a surprising 23% are still given medical images on physical films.
According to the survey, 66% of respondents have access to at least one portal connected to their provider's electronic health record (EHR). However, only 18% of patient respondents have been able to ever receive records of any type digitally (via email, app, or through a portal).
This indicates that records and information are still not being effectively shared, even though the patients may have access to portals. The survey was taken in early March, right before the pandemic gripped the country. Since then, the serious consequences of this lack of interoperability have only gotten worse.
According to the U.S. Centers for Disease Control and Prevention (CDC), only 5.8% of known COVID-19 cases had data available on underlying health conditions and other known risk factors for severe outcomes from respiratory infections. However, making both diagnostic images along with other forms of medical data available and shareable can vastly improve diagnosis, treatment, and evaluation in critical care delivery. It can help accelerate clinical knowledge for R&D efforts in therapy and vaccine development. And who wants to be running around with CDs being carried into institutions in the midst of a pandemic?
Long before COVID-19 struck, the ONC demanded that interoperability be addressed by giving patients greater control of their longitudinal data to collect and share with a care team or to play a role as a "citizen scientist" to share with a research team working furiously to fast-track development.
Not off the hook
The practical reality is that delivery systems are dealing with a pandemic. They need to be able to focus on patient care right now and not on technical upgrades and the implementation of new technology that's not immediately related to a public health response. The other reality is that many hospitals have furloughed technical and administrative staff, limiting their ability to plan and implement new technologies.
Healthcare technology companies, however, are less impacted and should be required to complete their plans to meet the interoperability standards. This will enable the healthcare delivery system to get back on track more quickly when the public health crisis is under control.
When the time is right, the ONC's interoperability rules will drive a cultural shift within institutional practices to change approaches at a practice level that inhibit the inclusion of imaging and other complex clinical data with the rest of a patient's history. Ironically, even as the rules face a short-term delay, this public health crisis is making the danger of noninteroperability to patient care shockingly visible.
Matthew A. Michela is president and CEO of Life Image, a medical image-sharing technology developer.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
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